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HomeMy WebLinkAbout4560 Larkbunting Dr - Applications/Reroof - 08/21/2014 (2)08/22/2014 08:36 197 211 ROCKY MTN ROOFERS PAGE 10/10 City of �,.F,�ort of.Collins 0Vo-7 This application is to be uskd to 0 Demoiftion (interior non-structur 13 Heating Unit ❑ Lawn Sprinkler 0 Ventilation ❑ Water Heater CI' manufacturer). Complete all applicable Intormal �.... Planning, Deirelopment & Transportation 281 N. College Ave P.O. Box soo Fort Collins, CO 8OS24 1. Phone 970-416-2740 Fax 224-6134 PERMITS ONLY )ly for the following permits only (check all that apply). ❑ Air Conditioning © Flectricat Alteration (not service change) p Gas Lighter ❑ Gas Log Mobile Home replacement fi!KFloofing U Sewer Line 0 Photo -voltaic er Line ❑ WOod/Peilet Stove (must be EPA certified, provide make, model and incomplete applications will not be accepted. Date & ZA - lob Site Address (requireO : i Value of Construction (tabor, materials, profit) n .Al Ire U $ t Af: � (77i Property Owner Name (A Address L023, Crlyy/State zip Phone gq Applicdnt Name ! Address City/State Zip Phone Contradnr Lfc #,R 1 1oCKr Y1�wan�c�f r\ V-ez 133 Address �. L i City/State Zip 1n� �iG `C�aZ Phone C�-10 zZ� 1-1���t7 Contractor City of Ft. Collins Sples I Siks tar mm bens requ isd by 0 cdnbadn ax # u 1 'J`1LP Are'y ou paying taxes here or by report? © Here Are you paying with your trust account? )# Yes 0 Report ❑ No is this a residential or commercial p 10 Residential U Commercial If residential, Is it: E3 Single mIN Detached 0 Condo/townhotft (single family attached) Duplex 110 Muldfa"Iy (E partment) 13 Garage If enrnmerrial,'fs It ❑ Bank b Bai © Church ❑. Hotel/Motel ❑ Medical office 13 Office © Retail E3 Restaur;•ant © Other (explain) Is this building 50 years of agaa ar re? O Yes ClNo IY` ) , yotr may need to cnnlad Hlstork Pmsetmdon If this is for a demolition perrhit, at year was the building constructed? rfprior to 1975, ^ toil need an aunt to submrt with this appftabbn. Description of work ' S � *If lawn sprinlder/badc low preventer; r Subcontractors, W Me ermp0ynai ElecGiGan^ _ Plumber iust list licensed plumber. If first-time A/C, must list licensed el Tian. PieorQyofftCo#insr1camjo ({y``((t.•�r�cw` i ��,vq Mechanical Roofer �Ottler I hereby acknowledge that I comply with all requirements permit is not valid until it Appliearh Print Name: read this appfiCatiOh and state that the above information is complen and Correct I agree to ►fined 1wein and city ordlnantes and slate laws regulating building construction. I know that a bmiani paid and issued. signature Date } Z` - 6